Nevada Health Information Exchange DRAFT Health Information Exchange .

1. EXECUTIVE SUMMARY NHIE will award a contract to a HIE Vendor that will provide the software and services necessary to implement and operate the technical components required for the Nevada State-wide HIE system. To be successful, the HIE Vendor must provide a HIE platform and associated services that will: Support high quality, safe, and efficient health care services; Deliver HIE-based information services to all providers operating in the State including and especially Medicare and Medicaid providers who will be eligible for incentive payments; Ensure the privacy and security of personal health information, both stored and exchanged; Enable intra-state, inter-state and nationwide health information exchange; Provide for a centralized consumer/patient consent management capability; Facilitate two way exchanges of information between the health community and the State of Nevada departments and agencies supporting Nevadans’ health (e.g., DFHS of Medicaid care services; Public Health registries such as immunization, cancer; Secretary of State advanced directives); Support Meaningful Use requirements (Stages 1, 2, and 3); and Support the services and products called for as part of an overall NHIE business model that is financially viable and sustainable without state general funding. The following subsections address component strategies for the development of the Nevada state-wide HIE system. 1.1. OVERVIEW OF STATE-WIDE HIE SYSTEM REQUIREMENTS The envisioned Nevada state-wide HIE Network will be hybrid infrastructure model consisting of the NHIE run State-wide HIE System operating in partnership with HIE businesses that are or will operate within Nevada and neighboring states. This strategic approach enables commercial HIE/RHIO businesses to thrive within the state while the NHIE provides the “HIE of last resort” to ensure equal access to health information services for all residents and health consumers located in the State, and connectivity to the national HIE called eHealth Exchange (formerly NwHIN) to those HIE participants within the state requiring such connectivity for interstate interactions and with Federal Partners including Centers for Disease Control and Prevention (CDC), Indian Health Service (IHS), Veteran Affairs (VA), Social Security Administration (SSA), and the Department of Defense (DoD). The State-wide HIE System to be implemented by the HIE Vendor will be based on architecture that is open and utilizes standardized functions within a Service Oriented Architecture (SOA) framework that is compliant with industry standards as well as the State’s implementation of Medicaid Information Technology Architecture (MITA). For the State-wide HIE System, HIE Vendor will implement the core information services that will enable the delivery of ARRA objectives. NHIE Request for Proposals - HIE Vendor 1

The broad requirements the HIE Vendor must meet for the State-wide HIE System are described in Section 10 of the ONC approved State HIT Strategic and Operations Plan. Minimal elements of the Core Solution to be implemented by the HIE Vendor include: Master Patient Index that support patient identity and merge/split of patient records; Provider Directory (Facilities) services that enable master data management of facility information where care is being delivered to one or more patients; Provider Directory (Individual) services that enable master data management of information regarding individual care providers who are performing care for one or more patients; Access Control Services that automate policy and administrative rights that limit or control access to patient data (e.g., consent management); Centralize Consent Management Services that enable the Access Control Services to be made available to inter- and intra-state HIEs; Record Locator Services that enable search for retrieval of federated patient data; Terminology Engine that normalizes the incoming medical coding and terminology into consistent forms enabling semantic interoperability (i.e., consistent meaning of health information regardless of its source); Messaging and Interoperability Services that enable reliable and secure flow of information via standard messages that are implemented utilizing open interoperability standards and follow interoperability profiles defined by IHE (Integrating the Health Enterprise); Clinical Portal Services that enable authorized providers and other care givers to view a personal health record via a user interface that facilitate quick and easy understanding of a patient’s health status and history while enabling easy access to detailed care information; Federal Partner Gateway Services that are certified and meet agreed integration standards for the sharing of patient information between HIEs operating in Nevada and the Federal Partners; State Agency Gateway Services (e.g., Medicaid, Immunization, etc.) that are certified and meet agreed integration standards for the sharing of patient information between HIEs operating in Nevada and the various health registries and health programs; Clinical Data Repository Services that will enable the storing of patient health information to the extent it is agreed by patients and aligned with State and Federal laws, regulations, and policies; Security Controls including authorization, authentication, access, audit, and breach reporting, and Performance Reporting Services that provide access to operational information about the HIE (e.g., numbers of messages by message type, by provider type; number of users by type, system outages, etc.). Optional elements to be implemented by the HIE Vendor include: EHR for Physician Practices; Analytic Services; Clinical Decisions Support Services; Specialist Portal Services (e.g., emergency services, urgent services, etc.); Clinical Alerts and Notifications – Providers/ACOs; NHIE Request for Proposals - HIE Vendor 2

Clinical Alerts and Notifications – Payers for Managed Care; Clinical Alerts and Notifications – Patients; and Telehealth/Telemonitoring Support Services (e.g., messaging, portals, storage of clinical data, etc.). 1.2. OVERVIEW OF HIE VENDOR SERVICES In addition to the Core HIE Solution, the selected HIE Vendor will be required to provide a series of services over a 3-5 year period of performance. These services include: System Implementation Services; Hosting Services; Administrative & Operational Support; Business Development Support; Outreach Services and Promotional Materials; Value-add HIE Solutions; and Enterprise HIE Services (optional). NHIE Request for Proposals - HIE Vendor 3

2. BACKGROUND: NHIE OPERATIONAL FRAMEWORK At its foundation, NHIE’s basis for existence derives from Nevada’s HIE vision, and the principles and values emanating from it. As context for the explanation of NHIE’s roles, responsibilities and organization relationships, the NHIE Vision and Mission statements are reiterated below. 2.1. NEVADA HIE VISION The NHIE vision continues to be to establish a sustainable State-wide HIE business that delivers an information exchange capability and encourages broad use of health information services to improve and innovate the delivery of wellness and care to individuals in the State. The information exchange capability will enable the sharing of health care data across organizational boundaries (inter- and intrastate lines) and will eventually be shared with consumers to improve patient care coordination and safety, mitigation of medical errors and reduce unnecessary and duplicate testing. The state of Nevada supports a resident population of approximately 2.7 million, with a transient population that reaches as much as 40 million or more. In addition to supporting native, resident Nevadans, the NHIE will also support this transient population that comes into the State as a result of the gaming and tourism industry. For this transient population, HIE services are essential to expedite routing and delivery of accurate information and enabling quick, timely treatment. 2.2. NEVADA HIE MISSION STATEMENT “Provide affordable and easy-to-adopt Health Information Exchange Services for the Nevada Health Care community and beyond (interstate), and encourage broad use of these services.” 2.3. PRINCIPLES AND VALUES THAT GUIDE NHIE ROLES, RESPONSIBILITIES, AND RELATIONSHIPS The HIE Vision points to foundational principles and values which guide the design of NHIE Organization Landscape Model. To be successful and sustainable, the NHIE must: Support high quality, safe, and efficient health care services through improvements in continuity of care and better information for care decisions. Promote the benefits of health information exchange and the usage of the State-wide HIE system among providers, payers and patients. Provide the individual patients with access to their health information and supporting tools that empower them to participate in their health and wellness. Ensure the privacy and security of personal health information, both stored and exchanged. Enable intra-state, inter-state, and nationwide health information exchange. Operate within a governance structure that is transparent, includes stakeholder participation, and is in compliance with all state and federal laws and regulations. NHIE Request for Proposals - HIE Vendor 4 Comment [GCY1]: This is a full extract from the NHIE Organizational Framework & Operational Guidelines document. It may be more content than is useful for a HIE Vendor, but if an objective is to find a vendor that is willing to participate in some risk/reward opportunities, then they will need to see this level of detail.

Provide equal access for underserved and rural/frontier populations as well as those in the urban areas. Deliver HIE-based information services to Medicaid providers and to the Medicaid organization for improved care delivery to the State’s Medicaid population. Deliver HIE-based information services to Nevada State agencies both within the Department of Health and Human Services (DHHS) as well as those in other State departments (e.g., Department of State, Department of Corrections, Department of Insurance). Effectively manage Cooperative Agreement resources as a one-time investment to enable longterm value for Nevadans and the Nevada health community. Establish a HIE business that is operationally and financially feasible, achievable, and sustainable. Help ensure HIE capabilities are available to enable meaningful use outcomes for health systems and providers. Facilitate adoption of health information services for Nevada patients and across relevant stakeholder organizations (e.g., hospitals, practices, payers, State agencies) across a broad range of uses and scenarios. Proactively foster innovation and adapt to emerging trends, standards and developments, both locally and nationally. 2.4. THE NEVADA HIE ORGANIZATION LANDSCAPE The model presented in Figure 1-1 depicts the major organizations of Nevada’s HIE environment and the salient relationships among them. Other than the NHIE, the organizations represented in this model are well known as key participants in the Nevada health community and patients’ value chain. NHIE Request for Proposals - HIE Vendor 5

Figure 1-1: Nevada HIE Organizational Landscape DHHS Director Internal Perspective Participates on Board NHIE Board of Directors NHIE Committees/ Workgroups Oversees NHIE Contracts to Participate NHIE Chief Executive Contracts with NHIE to Provide Services as the State HIE defined by State law. NHIE Operations Marketing & Sales Contracting & Operations HIE Technical Operations Financial Operations Human Resources etc. Contracts for Services HIE Solution Supplier(s) Certifies HIE to be able to participate Provides Consent / Subscribes for Services Certified for NwHIN Contracts to Participate NV Certified HIEs Private HIEs Hospital HIEs Certified Participants Care Organizations (Hospital, Practices, etc.) Ancillary Health (Laboratories, Radiology Centers) Provides Consent Consumer/Patient Federal Partners (ONC, CDC, CMS, VA, etc.) Commercial Payers Sponsors Nevada HIE Contract to Participate in Nevada HIE Industry Sectors State State State Agency State Agency Agency Agency OR Other Suppliers State Virtual HIE State State State Agency State Agency Agency Agency By statute, the NHIE Board, under direction of the DHHS Director, will be the “governing body” for health information exchange in Nevada as well as a HIE service provider to patients and health organizations. The NHIE Executive Director will lead the NHIE Corporation, which is the “governing entity” as defined in statute. Relationships among HIE organizational components will be controlled by combination of statute, policy, regulation, contractual agreement, and participation agreement. The organizations and the formalization of their relationships amongst each other will be used to execute the Nevada HIE mission. Key elements of that mission are to realize: Compliance with Federal laws, regulations, and policies, Compliance with Nevada State statutes and regulations, Advancement of the NHIE goals and objectives, and Achievement of the vision for Nevada HIE. The sections that follow provide a description of the operational-level responsibilities, relationships, and accountabilities of the organizational entities existing in the Nevada Health Information Exchange (NHIE) landscape. These include the following major organizational entities: DHHS Director, NHIE Board of Directors and its Workgroups and Committees, the NHIE Non-Profit Operating entity, and “customers”/stakeholders (patients) of NHIE. NHIE Request for Proposals - HIE Vendor 6

2.5. DHHS DIRECTOR 2.5.1. SCOPE OF RESPONSIBILITY DHHS Dir

Enable intra-state, inter-state and nationwide health information exchange; Provide for a centralized consumer/patient consent management capability; Facilitate two way exchanges of information between the health community and the State of Nevada departments and agencies supporting Nevadans' health (e.g., DFHS of Medicaid care